House Speaker Nancy Pelosi, D-Calif., from left, is joined by other House Democratic leaders, House Majority Leader Steny Hoyer of Maryland, Pete Stark of California, Henry Waxman of California, Charles Rangel of New York, and John Dingell of Michigan, in a news conference, announcing the introduction of health care legislation on Capitol Hill, Tuesday, July 14, 2009, in Washington.

The debate on health care reform is starting to turn ugly. Those who want to increase government power to rule American medicine are adding physicians to their list of “enemies of the people.” We hear frequently that insurers and drug companies are inefficient and greedy businesses that must be replaced by efficient, enlightened and compassionate government bureaucracies. Now doctors are coming under attack for daring to resist government attempts to tell them how to practice medicine.

In an editorial last month in the New York Times, readers were told, “Doctors have been complicit in driving up health care costs.” “Complicit” is an ominous term, often used in a legal or criminal context. Such language is obviously intended to intimidate physicians into submission.

How are doctors “complicit” in rising costs? The Times tells us they are to blame because “doctors largely decide what medical or surgical treatments are needed,” which makes many of them “unabashed profiteers.”

Such a statement provides two keys to understanding the debate on health care reform.

The first and most obvious is that reform advocates in government want the legal power to prevent doctors from deciding “what medical or surgical treatments are needed.” They think that role must be reserved for politicians and government officials. Physicians must not be allowed to prescribe a drug if the government decides it helps only some but not all patients and is thus not “comparatively effective.”

Physicians must conform to new government “protocols” in providing treatment, not their own judgment. If they do not, the government will make them more liable to malpractice suits for not doing it the government way. They are now forced to computerize their patients’ medical records and turn them over to the government – without the patients’ permission – to better help the government supervise their practice.

Also revealed by the Times’ editorial is the attempt to disarm doctors morally and politically so they will do what they are told. Any attempt to protect their ability to practice medicine as they think best will just prove that they are greedy profiteers, like businessmen. Anyone who makes a living or runs a profitable business that does not need to be bailed out by the government may be condemned.

Conversely, greed for power is a saintly virtue for those who want to instruct physicians how to run their practices.

From other quarters we hear arguments that doctors should just do what they are told and accept what the government pays them, even if it does not cover their costs, because they owe us all for their medical education. Never mind the huge debts with which most MD’s graduate from medical school. Never mind the long years and long hours of medical education and internship. If they went to a public school, never mind the taxes their parents paid to support it. If the government gives you an education, these politicians say that you owe that government your life. Are we now discovering the true purpose of government-controlled education?

Doctors are probably coming under attack now because even the American Medical Association – not known in recent years for its resistance to government incursion in medicine – is showing a bit of backbone in opposing proposals such as a new “public option” for medical insurance. The AMA is to be encouraged. If physicians do not take a stand to defend their rights to their own lives, their careers and their freedom to practice medicine, and, yes, to decide with their patients “what medical or surgical treatments are needed,” who will?

We will not preserve our freedoms or our health if we as physicians and patients surrender our rights to politicians in return for their promises to take care of us.